Health Care Options at a Glance
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posted Aug 22, 2006
| Type | Socialized | Single-Payer |
Nonprofit Multi-Payer |
Corporate Health Care |
| Example |
 Britain (also, the Veterans Administration) |
 Canada |
 France |
 United States |
| How It Works | Government hires doctors and runs hospitals. | Doctors have private practices, hospitals may be owned by nonprofits or by government. Government pays the bills based on fee structures negotiated with health care providers. | Medical practices and hospitals are private (nonprofit or for-profit). Nonprofit, regulated "sickness" funds collect payments and pay health care bills under the terms of a negotiated fee structure. | Individuals or employers purchase coverage from mostly for-profit insurance companies. The elderly, disabled, veterans, some children, some low income people are covered through public programs. |
| Who Pays | Government | Government | Payroll contributions (compulsory) from employers and employees. Funds cover 75% of medical bills. Remainder comes from government, patients, and supplemental insurance. | Employers and individuals pay premiums. Most plans require co-pays and deductibles, and some costs are excluded. Government subsidizes employer plans through tax breaks and covers some families through publicly funded programs. |
| Who Chooses Doctor | Patient | Patient | Patients | Choice restricted by insurer; penalties may apply for seeing "out-of-network" provider. Some providers don't take Medicaid or Medicare. |
|
Who Is Covered
|
Everyone | Everyone (NOTE: This is the system proposed in Rep. John Conyers National Health Insurance Act, HR 676.) | 99% of population | Those with insurance, those covered by the Veterans Administration (which works like socialized medicine), Medicaid, and Medicare (which function like single-payer systems). Those with chronic illness or pre-existing conditions may not be able to find coverage at any price. About 50 million have no insurance, including nine million children. |
| Cost per capita: | $2,389 | $2,989. | $2,902. | $5,711 |
| WHO rank* | for Britain: 24 | for Canada: 35 | for France: 4 | for U.S.: 72 |
|
*The World Health Organization (WHO) performance on level of health ranking measures how efficiently a system translates spending into overall health -- a "bang for the buck" rating. |
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| Type | Health Savings Accounts | Individual Mandate | Tax Credit | Buy-in Option* *under consideration |
| Example | U.S. as of 2004 | Massachusetts as of 2006 | ||
| How It Works | Individuals buy high-deductible insurance and they (or employers) contribute to tax-free savings accounts used to pay bills. | All are required to carry insurance, through employers or by buying their own policy. | Tax credits offset the cost of private insurance premiums. | How it would work: Under a plan studied by the National Coalition on Healthcare, the uninsured could buy into Medicaid, Medicare, or SCHIP |
| Who Pays | Individuals, employers, and government (through tax breaks). | Individuals, employers, government (subsidizes premiums and offers Medicare for the low-income). | Individuals and government (via tax breaks). | Individuals pay on a sliding scale, with government subsidy sufficient to make it affordable. |
| Who Chooses Doctor | Plans may restrict doctor choice. | Insurance plan. Medicare recipients choose any doctor who accepts Medicare. | Who chooses doctor: Restricted by insurance plan. | Private plans determine choices. Publicly covered patients choose participating doctors. |
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Who Is Covered
|
Appeals to those with low medical expenses. Low-income people and those with accounts too low to cover deductibles are on their own. | In theory, all. But barriers remain for low income families. | Who is covered: Those who qualify for a tax credit and can afford to make premium payments. Some proposals call for restricting the credit to low-income people. | Everyone |
| Costs | Requires complex expense tracking. Incentive to postpone preventive care. Cost controls not addressed. | Government subsidy makes coverage affordable to some low-income families, but there is no change to the main drivers of high costs. | Tax breaks offset premium costs, but there is no provision for impoverished families. Individuals still pay co-pays, deductibles, etc. There is no change to the main drivers of high costs. | NCHC says in the first decade health care savings would total $320.5 billion; businesses now providing health insurance would save $848 billion, and families who currently carry insurance would save $309 billion. |
Gelder, S. v., Pibel, D. (2006, August 22). Health Care Options at a Glance. Retrieved November 20, 2009, from YES! Magazine Web site: http://www.yesmagazine.org/issues/health-care-for-all/1515.
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